Provider Demographics
NPI:1932356946
Name:YOHANNAN, WENDY SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SUE
Last Name:YOHANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1011
Mailing Address - Country:US
Mailing Address - Phone:201-393-6330
Mailing Address - Fax:201-462-4706
Practice Address - Street 1:1 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1011
Practice Address - Country:US
Practice Address - Phone:201-393-6330
Practice Address - Fax:201-462-4706
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173960207ZP0102X
NJ71763207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology